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Aetna Medicare Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Value (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in SW MO / SE KS Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Value (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3600.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Value (HMO-POS) plan has a $590 deductible for prescription drugs. After meeting the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, but a $12 copay at standard pharmacies and standard mail order. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you'll pay 24% or 25% coinsurance, depending on the drug and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Value (HMO-POS) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, while outpatient services like doctor visits and many diagnostic tests have either no copay or a relatively low copay. Additional benefits include coverage for hearing, vision, and dental services, with specific copays and maximum benefit amounts, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $310 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $310 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays are not covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered under the Aetna Medicare Value (HMO-POS) plan. Outpatient Hospital Services have a copay of $0 to $275, Observation Services have a copay of $310, Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a copay of $30 per session, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO-POS) plan. The plan has a $55 copay for this benefit, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (HMO-POS) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance; transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Value (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $140 copay, while Worldwide Emergency Transportation has a $295 copay; Urgently Needed Services have a $30 copay. There is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Value (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and routine chiropractic care is not covered. Occupational therapy services have a $30 copay, and physical therapy and speech-language pathology services have a $30 copay. Physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services have varying copays. Additional telehealth benefits are covered with a 20% coinsurance and a copay that ranges from $0 to $30.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services which may have a copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing services with the Aetna Medicare Value (HMO-POS) plan include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $175 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay, and other dental services with a maximum benefit of $2500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Orthodontic Services are covered under Diagnostic and Preventive Dental, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered by Aetna Medicare Value (HMO-POS), including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a coinsurance of 0-20%, while durable medical equipment for use outside the home is not covered. Prosthetics and medical supplies have a coinsurance, while diabetic supplies have a coinsurance of 0-20%, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $30, and lab services with no copay. Radiological Services are covered with a copay of up to $140 for diagnostic services, and a coinsurance of at least 20% for therapeutic services. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value (HMO-POS) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered, as well as non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Aetna Medicare Value (HMO-POS) covers acupuncture with a $20 copay, over-the-counter items with no copay, and a meal benefit with no copay. The plan also covers other services, but does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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